Anaphylaxis

shock, danger in pediatrics , emergency in pediatrics, anaphylaxis in children

1. Anaphylaxis Dr. Virendra Kumar Gupta Assistant Professor Department Of Pediatric Gastroentero-hepatology & Liver Transplantation NIMS Medical College & Hospital , Jaipur

2. Objectives Define Hypersensitivity Reaction. Mention the Types of Hypersensitivity Reactions. Define Anaphylaxis. Mention the Etiologic Causes. Explain the Pathophysiologic Mechanism. Mention the Signs & Symptoms. Demonstrate the Diagnostic Investigations. Display the Treatment & First Aid.

3. Hypersensitivity Reaction Injurious, or pathologic, immune reactions are called hypersensitivity reactions. Hypersensitivity reactions may occur in two situations . First , responses to foreign antigens may be dysregulated or uncontrolled , resulting in tissue injury . Second, the immune responses may be directed against self antigens , as a result of the failure of self-tolerance ( autoimmunity ).

4. Types of hyper sensitivity reactions

5. Anaphylaxis Ana (without), phylaxis (protection ). Anaphylaxis is a sudden, severe allergic reaction that can be life-threatening. It can occur within seconds or minutes of exposure to something someone is allergic to IgE -mediated (type I) hypersensitivity reaction resulting in the release of potent chemical mediators Mast Cells Basophils Affects multiple organ systems Respiratory Cardiovascular Gastrointestinal Dermatologic Clinical Diagnosis Biphasic Reactions

6. Clinical Definition

7. clinical criteria Any one of the following three occurs within minutes/hours of exposure to an allergen there is a high likelihood of anaphylaxis : Involvement of the skin or mucosal tissue plus either respiratory difficulty or hypotension. Two or more of the following symptoms: a . Involvement of the skin or mucosa b. Respiratory difficulties c. Low blood pressure d. Gastrointestinal symptom Low blood pressure after exposure to a known allergy.

8. Etiology

9. Etiology

10. Pathophysiology

11. Pathophysiology

12. Signs & Symptoms Skin

13. Signs & Symptoms Eyes

14. Signs & Symptoms Nose & mouth

15. Signs & Symptoms Lungs and throat

16. Signs & Symptoms Heart and circulation

17. Signs & Symptoms Digestive system

18. Signs & symptoms Nervous system

19. Diagnosis The diagnosis of anaphylaxis is based upon symptoms that occur suddenly after being exposed to a potential trigger. Differential diagnosis severe asthma attack heart attack panic attack food poisoning An increased amount of tryptase protein can be measured in a blood sample collected during the first three hours after anaphylaxis symptoms have begun. tryptase levels are seldom elevated in food-induced anaphylaxis

20. First-Aid management of anaphylaxis 1. Seek emergency care Call for help 2. Inject Epinephrine Immediately Inject epinephrine into outer muscle of the thigh . 3. Do CPR if the Person Stops Breathing

21. First Aid

22. groups of drugs used Epinephrine: help maintain blood pressure, antagonize effects of released mediators, and prevent further release of mediators . Antihistamines (Diphenhydramine, Hydroxyzine): primarily effective against cutaneous effects of anaphylaxis.  H2 Receptor Antagonists (Cimetidine): block effects of released histamine at H2 receptors, thereby treating vasodilation. Bronchodilators (Albuterol): These agents stimulate beta2-adrenergic receptors in bronchial smooth muscle, causing bronchodilation.

23. Prevention

24. Question 1 A 5 year old M who has experienced a severe allergic reaction to shrimp in the past needs a CT scan with IV and oral contrast. What precautions should you take? A. NS bolus and diphenhydramine B. NS bolus, diphenhydramine, and prednisone C. This patient can not receive contrast D. Reassurance, there is no associated risk for a reaction between shellfish and contrast

25. Question 1 A 5 year old M who has experienced a severe allergic reaction to shrimp in the past needs a CT scan with IV and oral contrast. What precautions should you take? A. NS bolus and diphenhydramine B. NS bolus, diphenhydramine, and prednisone C. This patient can not receive contrast. D. Reassurance, there is no associated risk for a reaction between shellfish and contrast.

26. Question 2 You have been asked by a local school to provide recommendations about the use of self injectable epinephrine for anaphylaxis. What is the BEST response to give regarding anaphylaxis? A. A patient should not receive a second dose of epinephrine unless a physician is present B. Epinephrine reaches higher peak plasma concentrations in injected into the thigh rather than the arm C. Families should keep one epinephrine auto injector in the car in case a reaction occurs after school D. Subcutaneous injection of epinephrine is preferable to intramuscular injection

27. Question 2 You have been asked by a local school to provide recommendations about the use of self injectable epinephrine for anaphylaxis. What is the BEST response to give regarding anaphylaxis? A. A patient should not receive a second dose of epinephrine unless a physician is present B. Epinephrine reaches higher peak plasma concentrations in injected into the thigh rather than the arm C. Families should keep one epinephrine auto injector in the car in case a reaction occurs after school D. Subcutaneous injection of epinephrine is preferable to intramuscular injection

28. Question 3 A 14 y/o M who has seasonal allergies and moderate persistent asthma is currently receiving allergen immunotherapy. Today in clinic he received his usual allergen injection, but after 10 minutes, he started coughing and complaining of dyspnea and throat swelling. On physical exam he exhibits moderate respiratory distress and has diffuse expiratory wheezing on auscultation. No oropharyngeal edema noted. Vitals signs include a pulse ox of 97%, BP of 130/70, and HR of 90. Of the following, the MOST appropriate next action is to administer : A. A short acting beta-2 agonist nebulization B. An oral antihistamine C. An oral corticosteroid D. Intramuscular epinephrine

29. Question 3 A 14 y/o M who has seasonal allergies and moderate persistent asthma is currently receiving allergen immunotherapy. Today in clinic he received his usual allergen injection, but after 10 minutes, he started coughing and complaining of dyspnea and throat swelling. On physical exam he exhibits moderate respiratory distress and has diffuse expiratory wheezing on auscultation. No oropharyngeal edema noted. Vitals signs include a pulse ox of 97%, BP of 130/70, and HR of 90. Of the following, the MOST appropriate next action is to administer : A. A short acting beta-2 agonist nebulization B. An oral antihistamine C. An oral corticosteroid D. Intramuscular epinephrine

30. Question 4 A 10 y/o M with a history of peanut allergy presents with diffuse itching and trouble breathing after eating a friend’s candy bar that contained nuts during school lunch. At the nurse’s office the patient received IM epinephrine with his EpiPen with symptom resolution. EMS was called and the patient was brought to the local pediatric ED (about a 12 minute ride). On arrival to the ED, the patient is again complaining of itching with an urticarial rash on his chest and per EMS the patient began vomiting as they were pulling up to the ambulance bay. Arrival vitals include a pulse ox of 96%, BP of 88/67, and HR of 95. Of the following, the MOST appropriate treatment plan is: A. Intramuscular epinephrine, oral antihistamine, oral corticosteroid, and a short acting beta-2 agonist neb treatment B. Intramuscular epinephrine, IV antihistamine, IV corticosteroid, NS bolus C. Intramuscular epinephrine, IV antihistamine, IV Zantac, NS bolus D. Intramuscular epinephrine, oral antihistamine, oral corticosteroid

31. Question 4 A 10 y/o M with a history of peanut allergy presents with diffuse itching and trouble breathing after eating a friend’s candy bar that contained nuts during school lunch. At the nurse’s office the patient received IM epinephrine with his EpiPen with symptom resolution. EMS was called and the patient was brought to the local pediatric ED (about a 12 minute ride). On arrival to the ED, the patient is again complaining of itching with an urticarial rash on his chest and per EMS the patient began vomiting as they were pulling up to the ambulance bay. Arrival vitals include a pulse ox of 96%, BP of 88/67, and HR of 95. Of the following, the MOST appropriate treatment plan is: A. Intramuscular epinephrine, oral antihistamine, oral corticosteroid, and a short acting beta-2 agonist neb treatment B. Intramuscular epinephrine, IV antihistamine, IV corticosteroid, NS bolus C. Intramuscular epinephrine, IV antihistamine, IV Zantac, NS bolus D. Intramuscular epinephrine, oral antihistamine, oral corticosteroid

32. Thank You